Postmodification with Polycations Enhances Key Properties of Alginate-Based Multicomponent Microcapsules.

Postmodification of alginate-based microspheres with polyelectrolytes (PEs) is commonly used in the cell encapsulation field to control microsphere stability and permeability. However, little is known about how different applied PEs shape the microsphere morphology and properties, particularly in vivo. Here, we addressed this question using model multicomponent alginate-based microcapsules postmodified with PEs of different charge and structure. We found that the postmodification can enhance or impair the mechanical resistance and biocompatibility of microcapsules implanted into a mouse model, with polycations surprisingly providing the best results. Confocal Raman microscopy and confocal laser scanning microscopy (CLSM) analyses revealed stable interpolyelectrolyte complex layers within the parent microcapsule, hindering the access of higher molar weight PEs into the microcapsule core. All microcapsules showed negative surface zeta potential, indicating that the postmodification PEs get hidden within the microcapsule membrane, which agrees with CLSM data. Human whole blood assay revealed complex behavior of microcapsules regarding their inflammatory and coagulation potential. Importantly, most of the postmodification PEs, including polycations, were found to be benign toward the encapsulated model cells.

Influence of Clinical and Genetic Factors on Propofol Dose Requirements: A Genome-wide Association Study.

BACKGROUND: Propofol is a widely used intravenous hypnotic. Dosing is based mostly on weight, with great interindividual variation in consumption. Suggested factors affecting propofol requirements include age, sex, ethnicity, anxiety, alcohol consumption, smoking, and concomitant valproate use. Genetic factors have not been widely explored. METHODS: This study considered 1,000 women undergoing breast cancer surgery under propofol and remifentanil anesthesia. Depth of anesthesia was monitored with State Entropy (GE Healthcare, Finland). Propofol requirements during surgery were recorded. DNA from blood was genotyped with a genome-wide array. A multivariable linear regression model was used to assess the relevance of clinical variables and select those to be used as covariates in a genome-wide association study. Imputed genotype data were used to explore selected loci further. In silico functional annotation was used to explore possible consequences of the discovered genetic variants. Additionally, previously reported genetic associations from candidate gene studies were tested. RESULTS: Body mass index, smoking status, alcohol use, remifentanil dose (ln[mg · kg-1 · min-1]), and average State Entropy during surgery remained statistically significant in the multivariable model. Two loci reached genome-wide significance (P < 5 × 10-8). The most significant associations were for single-nucleotide polymorphisms rs997989 (30 kb from ROBO3), likely affecting expression of another nearby gene, FEZ1, and rs9518419, close to NALCN (sodium leak channel); rs10512538 near KCNJ2 encoding the Kir2.1 potassium channel showed suggestive association (P = 4.7 × 10-7). None of these single-nucleotide polymorphisms are coding variants but possibly affect the regulation of nearby genes. None of the single-nucleotide polymorphisms previously reported as affecting propofol pharmacokinetics or pharmacodynamics showed association in the data. CONCLUSIONS: In this first genome-wide association study exploring propofol requirements, This study discovered novel genetic associations suggesting new biologically relevant pathways for propofol and general anesthesia. The roles of the gene products of ROBO3/FEZ1, NALCN, and KCNJ2 in propofol anesthesia warrant further studies.

Storylines of family medicine VIII: clinical approaches.

Storylines of Family Medicine is a 12-part series of thematically linked mini-essays with accompanying illustrations that explore the many dimensions of family medicine as interpreted by individual family physicians and medical educators in the USA and elsewhere around the world. In 'VIII: clinical approaches', authors address the following themes: 'Evaluation, diagnosis and management I-toward a working diagnosis', 'Evaluation, diagnosis and management II-process steps', 'Interweaving integrative medicine and family medicine', 'Halfway-the art of clinical judgment', 'Seamless integration in family medicine-team-based care', 'Technology-uncovering stories from noise' and 'Caring for patients with multiple long-term conditions'. May readers recognise in these essays the uniqueness of a family medicine approach to care.

Associations of menopausal status and eating behaviour with subjective measures of sleep.

Eating and sleeping behaviour are known to interact with each other, yet research is limited in the context of menopausal women. The aim of this study was to examine whether menopausal status is associated with perceived problems in sleeping. Furthermore, we studied different aspects of eating behaviour as potential risk factors for poor sleep in menopausal women. The present study is exploratory in nature, thus the results should be interpreted as hypothesis-generating. We analysed the sleeping and eating behaviour of 1098 women aged 47-55 years and represented different menopausal statuses with regression analyses. Over 20% of them reported fairly poor or poor perceived sleep quality. A higher number of postmenopausal women reported experiencing at least fairly poor sleep quality compared with the other menopausal groups. However, in regression models controlled for several confounding factors menopausal status was not associated with measures of sleep. Women who reported more snacking-type eating behaviour were more likely to report shorter sleep duration, and more daytime tiredness. Externally cued eating was associated with shorter sleep duration and emotional eating was associated with experiencing daytime tiredness. However, after adjusting for multiple testing, it appears that eating behaviour is associated only with daytime tiredness. Menopausal women with sleeping problems may benefit from nutritional interventions targeting eating behaviour.

Where Do Adults in the United States Obtain Cannabis? A Nationally Representative Study Examining the Relationships Between Sociodemographic Factors, Cannabis Use Characteristics and Sources of Cannabis.

OBJECTIVE: Characterization of population subgroups based on where they acquire cannabis is unexplored. We examine relationships between sociodemographic characteristics, cannabis use modality, risky cannabis use, and source of cannabis. METHOD: Analyzing a representative sample (unweighted n = 8,089) of U.S. adults living in medical cannabis-permitting states with past-year cannabis use from the 2021 National Survey on Drug Use and Health, we determined source of last cannabis used. Outcome groups were purchased from a dispensary, purchased from another source, or nonpurchased source. Incorporating the complex survey design, descriptive statistics and adjusted multinomial logistic regressions evaluated associations between sociodemographic, individual cannabis use characteristics, and source of cannabis. Secondary analyses described cannabis purchasing characteristics among the subsample who last purchased cannabis. RESULTS: Purchasing from a dispensary was the most common source of cannabis (42.5%). Significant relationships between sociodemographic characteristics, cannabis use modality, risky cannabis use, and source of cannabis were found. Recent cannabis initiates and those with cannabis vaporizer use had an increased likelihood of purchasing cannabis from a dispensary. Purchasing from a nondispensary source was most likely among those with daily cannabis use, past-month blunt use, past-year driving under the influence, cannabis use disorder, and cannabis and alcohol co-use. Among those purchasing cannabis, joints and other forms of cannabis were more likely to be purchased from a dispensary than purchased from other sources. CONCLUSIONS: We identified key sociodemographic and cannabis use characteristics that may influence where individuals obtain cannabis, which are important for cannabis behavior surveillance and cannabis use prevention and intervention strategies to consider.

Análisis de riesgos mediante modelos big data del uso de medicamentos peligrosos en Unidades de Hospitalización a Domicilio: protocolo de estudio / Assessing the risk of using hazardous drugs in Hospital-at-Home Units: a big data study protoco

Objetivo: Describir el protocolo del estudio para la instauración del control del proceso de los medicamentos peligrosos que asegure la calidady su trazabilidad, mediante el análisis de riesgos, desarrollando e implantando una herramienta informatizada que, gracias a la utilización de técnicas de big data, permita conocer y auditar el conjunto del sistema de formacontinua y dinámica.Método: Mediante los procesos de notación gráfica normalizada Business Process Model Notation se desarrollarán los flujogramas específicosque permitan conocer las etapas del proceso de los medicamentos peligrosos que determinen la trazabilidad total del sistema. Cada una de lasetapas será recogida en los cuadros de gestión, donde a través de laprobabilidad del suceso y su gravedad se calculará el índice de criticidadde cada punto de control que se determine, y se establecerán las medidasde control. A partir de los cuadros de gestión se desarrollará el soportetecnológico para la captura de todos los datos que sean pertinentes al modelo. Para asegurar el control de la calidad del proceso se optará poragentes software cliente, que permitan en fases posteriores aplicar herramientas eficientes en el procesamiento de datos de modo automático. Apartir de aproximaciones metodológicas del big data, y en particular delámbito de machine learning, se desarrollarán algoritmos sobre el repositorio de datos generado para poder obtener patrones que permitan mejorarlos protocolos de aplicación. Por último, para asegurar el funcionamientodel proceso se realizará la verificación clínico-farmacéutica y la revisióncompleta, técnico-documental, de los sistemas de control y registro. (AU)

Objective: This article describes a study protocol for the implementation of quality and traceability control in the hazardous medication circuitthrough an analysis of risks and the development and introduction of a BigData-based software application aimed at performing a continuous anddynamic audit of the whole system.Method: A standardized graphical modeling tool called Business Process Model Notation will be used to generate a detailed description ofeach of the stages in the hazardous medication circuit with a view to ensuring full traceability of the system. The information on each stage will becollected in a flowchart, which will be used —together with each event’slikelihood of occurrence and severity— as a basis to calculate the criticality index of the different control points established and to determine anycontrol measures that may be required. The flowcharts will also be usedto develop the technological support needed to capture all such data asmay be relevant to the model. Proper quality control of the process will be ensured by client software agents intended to allow automatic application of efficient data processing tools at the different phases. In addition,Big Data methodologies, in particular machine learning, will be used todevelop algorithms based on the repository of generated data to comeup with patterns capable of improving the protocols to be applied. Lastly,proper operation of the process will be ensured by means of clinicalpharmaceutical verification and a full technical-documentary review ofcontrol and registration systems. (AU)

Manejo urológico y procedimientos quirúrgicos en migrantes del África Subsahariana con esquistosomiasis urogenital / Urological management and surgical procedures in migrants from Sub-Saharan Africa with urogenital schistosomiasis

Introducción y objetivos: Tras el flujo migratorio procedente del África Subsahariana (ASS) en Europa, el número de diagnósticos de esquistosomiasis urogenital (EUG) es cada vez mayor. Este fenómeno representa un desafío para los urólogos que trabajan en zonas no endémicas. El objetivo de este estudio es describir el tratamiento urológico y los procedimientos quirúrgicos de los pacientes con EUG en un centro de referencia terciarioPacientesTodos los sujetos del ASS diagnosticados con EUG entre enero del 2011 y noviembre del 2018 fueron inscritos retrospectivamente. Se recogió y analizó la información detallada de los pacientes con EUG tratados mediante procedimientos urológicos.ResultadosTreinta pacientes fueron diagnosticados con EUG, 12 (42,8%) fueron tratados mediante cirugía. El procedimiento quirúrgico más común fue la resección transuretral de vejiga (RTUV) para las lesiones sospechosas persistentes después del tratamiento con praziquantel administrado en 7 casos (58%). Otros procedimientos quirúrgicos (realizados una vez) fueron RTUV combinada con ureteroscopia láser por sospecha de neoplasia de vejiga con cálculos renales, litotricia endoscópica y nefrolitotomía percutánea para cálculos vesicales y renales, nefrectomía laparoscópica para enfermedad renal terminal, colocación de nefrostomía bilateral para hidroureteronefrosis, cirugía testicular exploratoria por sospecha de torsión testicular. Cuatro pacientes (33%) se perdieron en el seguimiento.ConclusiónSe ha observado un número cada vez mayor de migrantes del ASS diagnosticados con EUG. Algunos pacientes requirieron intervención quirúrgica por sospecha de lesiones neoplásicas o daños en órganos en fase terminal. En varios pacientes fue particularmente difícil realizar un seguimiento regular. Se necesitan más estudios multicéntricos para lograr un manejo estándar en términos de diagnóstico, tratamiento y seguimiento de los sujetos con EUG. (AU)

Introduction and objectives: An increasing number of urogenital schistosomiasis (UGS) is being diagnosed in Europe following the unprecedented migratory flux from Sub-Saharan Africa (SSA). This phenomenon represent a challenge for urologists working in a non-endemic area. The aim of this study is to describe the urological management and the surgical procedures of patients with UGS in a tertiary referral centre.PatientsAll subjects from SAA diagnosed with UGS from January 2011 to November 2018 were enrolled retrospectively. Detailed data of patients with UGS undergoing to urological procedures were collected and analysed.ResultsThirty patients were diagnosed with UGS, among them 12 (42.8%) were submitted to surgery. The most common surgical procedure was trans urethral resection of bladder (TURB) for suspected lesions persisted after praziquantel treatment performed in 7cases (58%). Other surgical procedure were TURB and concomitant ureteroscopy with laser fragmentation for suspected bladder neoplasm with renal stone, endoscopic lithotripsy and percutaneous nephrolithotomy for bladder and renal stones, laparoscopic nephrectomy for end-stage kidney disease, placement of bilateral nephrostomy for hydroureteronephrosis, explorative testicular surgery for a suspected testicular torsion in one case each. Four patients (33%) were lost at the follow up.ConclusionAn increasing number of migrants from SSA diagnosed with UGS has been observed. Some patients required a surgical intervention for suspected neoplastic lesions or end-stage organ damage. It was particularly difficult to perform a regular follow-up in several patients. Further multicentric studies are needed to reach a proper standard in diagnosis, treatment and follow-up of subjects with UGS. (AU)

Recent smell loss is the best predictor of COVID-19: a preregistered, cross-sectional study

BackgroundCOVID-19 has heterogeneous manifestations, though one of the most common symptoms is a sudden loss of smell (anosmia or hyposmia). We investigated whether olfactory loss is a reliable predictor of COVID-19. MethodsThis preregistered, cross-sectional study used a crowdsourced questionnaire in 23 languages to assess symptoms in individuals self-reporting recent respiratory illness. We quantified changes in chemosensory abilities during the course of the respiratory illness using 0-100 visual analog scales (VAS) for participants reporting a positive (C19+; n=4148) or negative (C19-; n=546) COVID-19 laboratory test outcome. Logistic regression models identified singular and cumulative predictors of COVID-19 status and post-COVID-19 olfactory recovery. ResultsBoth C19+ and C19-groups exhibited smell loss, but it was significantly larger in C19+ participants (mean{+/-}SD, C19+: -82.5{+/-}27.2 points; C19-: -59.8{+/-}37.7). Smell loss during illness was the best predictor of COVID-19 in both single and cumulative feature models (ROC AUC=0.72), with additional features providing negligible model improvement. VAS ratings of smell loss were more predictive than binary chemosensory yes/no-questions or other cardinal symptoms, such as fever or cough. Olfactory recovery within 40 days was reported for [~]50% of participants and was best predicted by time since illness onset. ConclusionsAs smell loss is the best predictor of COVID-19, we developed the ODoR-19 tool, a 0-10 scale to screen for recent olfactory loss. Numeric ratings [≤]2 indicate high odds of symptomatic COVID-19 (4

Effects of HIV infection on maternal and neonatal health in southern Mozambique: A prospective cohort study after a decade of antiretroviral drugs roll out

The HIV epidemic is concentrated in sub-Saharan Africa. However, limited information exists on its impact on women and infant's health since the introduction of antiretroviral drugs in this region, where health resources are often scarce. Methods: The effect of HIV infection on maternal health, birth outcomes and infant health was analysed in two contemporary cohorts of HIV-uninfected and HIV-infected pregnant women from southern Mozambique. Pregnant women attending the first antenatal care visit were followed until one month after delivery. Antiretroviral therapy was administered based on CD4+T cell count and clinical stage. Maternal and neonatal morbidity and mortality, as well as pregnancy outcomes were assessed by mother's HIV status. Results: A total of 1183 HIV-uninfected and 561 HIV-infected pregnant women were enrolled. HIV-infected women were more likely to have anaemia both at the first antenatal care visit and at delivery than HIV-uninfected women (71.5% versus 54.8% and 49.4% versus 40.6%, respectively, p<0.001). Incidence of hospital admissions during pregnancy was increased among HIV-infected women (RR, 2.04, [95%CI, 1.45; 2.86]; p<0.001). At delivery, 21% of HIV-infected women reported being on antiretroviral therapy, and 70% having received antiretroviral drugs for prevention of mother to child transmission of HIV. The risk of stillbirths was doubled in HIV-infected women (RR, 2.16 [95%CI 1.17; 3.96], p = 0.013). Foetal anaemia was also increased among infants born to HIV-infected women (10.6% versus 7.3%, p = 0.022). No differences were found in mean birth weight, malaria, prematurity and maternal and neonatal deaths between groups. Conclusions: HIV infection continues to be associated with significant maternal morbidity and poor neonatal health outcomes. Efforts should urgently be made to identify the barriers that impede improvements on the devastating effects of HIV in African women and their infants.

Cetacean sightings and acoustic detections during a seismic survey off Nicaragua and Costa Rica, November-December 2004 / Avistamientos y detecciones acústicas de cetáceos durante un sondeo sísmico en aguas fuera de las costas de Nicaragua y Costa Rica, en Noviembre y Diciem bre 2004

AbstractAlthough the wider Eastern Tropical Pacific has been systematically surveyed during summer/fall, relatively little effort has focused on shelf and slope waters of Nicaragua and Costa Rica. Such data are useful for establishing baseline information and assessing potential changes in cetacean occurrence and distribution relative to natural (e.g., El Niño-Southern Oscillation, climate change) and anthropogenic factors. A visualacoustic survey for cetaceans occurred as part of a monitoring and mitigation program during an academic geophysical seismic study off Nicaragua and Costa Rica, during November-December 2004. Approximately 2 067 cetaceans representing at least seven species were seen in 75 groups during 373 h (3 416 km) of daytime observations from the seismic research vessel (R/V) Maurice Ewing. The humpback whale (Megaptera novaeangliae) and the pantropical spotted dolphin (Stenella attenuata) were the most frequently sighted species (30 % of all groups sighted); both were seen in shelf waters < 100 m deep and in slope waters. The bottlenose dolphin (Tursiops truncatus; 10 % of sightings) was the third most frequently sighted species and was only seen in water > 100 m deep. In addition, sightings were made of spinner dolphins (S. longirostris), short-beaked common dolphins (Delphinus delphis), Risso's dolphins (Grampus griseus), short-finned pilot whales (Globicephala macrorhynchus), and unidentified dolphins and whales. Unconfirmed sightings of a minke whale (Balaenoptera acutorostrata) and a pod of false killer whales (Pseudorca crassidens) were also recorded. An additional six groups of dolphins (50 % confirmed to species, all pantropical spotted dolphins) were made during 187 h (1 549 km) of observation effort during darkness, two of which were detected within 30 m of the vessel bow using a night vision device. A total of 217 cetacean detections occurred during 633 h of passive acoustic monitoring. A small concentration of 12 humpback whales was seen in eight groups, and two humpbacks were recorded singing in the Gulf of Fonseca on 9 December 2004. To our knowledge, such concentrations of humpback whales, particularly singing humpbacks, have not been previously reported in this specific area. In addition, a humpback mother-calf pair, likely from the Northern Hemisphere population, was seen off Northern Costa Rica on 25 November 2004. Although cetacean sighting rates were significantly different during seismic and non-seismic periods even when corrected for differential detection probability related to sea conditions, our survey results do provide information to address previous data gaps on cetacean occurrence in shelf and slope waters off the Pacific coast of Central America during late fall.

ResumenAunque el ancho Pacífico Tropical Oriental ha sido sistemáticamente sondeado durante el verano/otoño, relativamente poco esfuerzo se ha aplicado tanto en aguas de la plataforma continental como el talud de Nicaragua y Costa Rica. Tales datos son útiles para establecer una información base y evaluar los cambios potenciales en la presencia y distribución relacionada tanto a factores naturales (ej., fenómeno de El Niño, cambio climático) como a factores antropogénicos. Un sondeo visual y acústico de cetáceos fue realizado como parte de un programa de monitoreo y mitigación durante un estudio académico de geofísica (sísmica) en las afueras de las costas de Nicaragua y Costa Rica durante Noviembre y Diciembre 2004. Aproximadamente 2 067 cetáceos representantes de al menos siete especies fueron avistados en 75 grupos durante 373 h (3 416 km) de observación diurna desde el buque de prospección sísmica (R/V) Maurice Ewing. La ballena jorobada (Megaptera novaeangliae) y el delfín manchado pantropical (Stenella attenuata) fueron las especies más frecuentemente avistadas (30 % de todos los grupos avistados); ambas fueron avistadas tanto en aguas de la plataforma continental < 100 m de profundidad como en aguas del talud. El delfín nariz de botella (Tursiops truncatus; con un 10 % de los avistamientos) fue la tercera especie más avistada, solamente visto en aguas > 100 m de profundidad. Adicionalmente, se registraron avistamientos de delfines acróbatas (S. longirostris), delfines comunes de hocico corto (Delphinus delphis), calderones grises (Grampus griseus), ballenas piloto de aleta corta (Globicephala macrorhynchus) además de ballenas y delfines no identificados. También se registró un avistamiento no confirmado de una ballena de minke (Balaenoptera acutorostrata) y uno de un grupo de falsas orcas (Pseudorca crassidens). Un adicional de seis avistamientos de delfines (confirmándose en un 50 % de ellos para la especie de delfín manchado pantropical) se observaron durante 187 h (1 549 km) de esfuerzo durante lapsos de oscuridad, dos de los cuales se detectaron a 30 m de la proa de la embarcación utilizando dispositivos de visión nocturna. Un total de 217 detecciones de cetáceos ocurrieron durante 633 h de monitoreo acústico pasivo. Una pequeña concentración de 12 ballenas jorobadas fue avistada en ocho grupos, y dos jorobadas fueron registradas cantando en el Golfo de Fonseca el 9 de Diciembre 2004. Para nuestro conocimiento, tal concentración de ballenas jorobadas, particularmente jorobadas cantando, no han sido reportadas previamente en esta área específica. Adicionalmente, una pareja de jorobadas madre-cría, probablemente de la población del Hemisferio Norte, fue avistada en las afueras de la costa de Costa Rica el 25 de Noviembre 2004. A pesar de que las tasas de avistamiento fueron significativamente distintas durante los periodos sísmicos y no sísmicos, incluso siendo corregidos según la probabilidad de detecciones relacionadas a las condiciones del mar, nuestro sondeo provee información que cubre vacíos previos de datos en la presencia de cetáceos en las aguas tanto de la plataforma como del talud continental fuera de las costas del Pacífico de América Central durante el otoño tardío.

Molecular-based diagnosis of respiratory allergic diseases in children from Curitiba, a city in Southern Brazil

BACKGROUND: Prevalence of respiratory allergic diseases has increased worldwide. Identification of the aeroallergens involved in allergenic sensitisation is important for diagnosis, treatment and prevention. OBJECTIVE: To verify the molecular pattern of sensitisation to aeroallergens in patients with allergic respiratory diseases using microarray technique for specific IgE antibody detection. METHODS: Cross-sectional study of 101 children with allergic rhinitis was followed in an outpatient clinic. All patients had positive skin prick tests (SPT) to at least one of the following antigens: Dermatophagoides pteronyssinus, Blomia tropicalis, Blattella germanica, Lolium multiflorum, and dog and cat epithelium. Serum specific IgE antibodies (sIgE) to mites, animal epithelia, fungi, cockroach and pollens components were determined by ImmunoCAP ISAC. RESULTS: sIgE to group 1 and 2 mite allergens showed higher positive rates: Der p 1 (74.2%), Der p 2 (73.3%), Der f 1 (74.2%), Der f 2 (72.3%). sIgE to animal epithelia were less frequent, Can f 1, Can f 2, Can f 3 in 4.9%, 2.9%, 1.9% respectively and Fel d 1, Fel d 2, Fel d 4 in 16.8%, 0.9% and 1.9%. respectively. Sensitisation to fungi and cockroach were rare, except for Bla g 7, to which 16.8% were positive. There was no significant recognition for tree pollens group. For grass, sIgE were detected to Cyn d 1 in 16.8%, Phl p 1 and Phl p 4 in 14.8% and 12.9%, respectively. CONCLUSION: Knowing that the pattern of allergic sensitisation varies according to environment and population, our results reinforce the need for local studies, using molecular-based diagnosis

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Bajo peso al nacer y sus factores asociados en el Hospital Materno infantil Germán Urquidi. Cochabamba, Bolivia / Low birth weight and associated factors in Hospital Materno Infantil Germán Urquidi. Cochabamba, Bolivia

INTRODUCCIÓN: el Bajo Peso al Nacer, definido por la Organización Mundial de la Salud (OMS) como el peso al nacer menor de 2 500 gramos, independiente de la edad gestacional y cualquiera que sea la causa; Es el índice predictivo más importante de la mortalidad infantil sobre todo la neonatal. OBJETIVOS: determinar la prevalencia de bajo peso al nacer y sus factores asociados en el Hospital Materno Infantil Germán Urquidi de la provincia Cercado del Departamento de Cochabamba, Bolivia, durante la gestión I- 2013. MÉTODOS: se realizó un estudio de tipo observacional, cuantitativo, descriptivo de corte transversal; con una muestra de 926 niños y niñas recién nacidos; seleccionados mediante un muestreo aleatorio simple, consideramos una seguridad del 95%, donde Alfa (α = 0,05 ) y Beta ( Z 1- α = 0,76) con una precisión d =0,049%, calculados mediante el Software PASS 12.0. RESULTADOS: del total de recién nacidos que ingresaron en el estudio (926); la prevalencia de bajo peso al nacer fue de 9,6%. Se determinó que con menor edad gestacional existe una menor Longitud al nacimiento (r = 0,5373). En relación de la edad de la madre con la edad gestacional no existió una relación estadísticamente significativa entre ambos (r = 0,005). CONCLUSIONES: la prevalencia de bajo peso al nacer en nuestro medio fue de 9,6%, los factores principales para un bajo peso al nacer fueron la edad gestacional y la talla baja la nacer.

Introduction: low birth weight, defined by the World Health Organization (WHO) as birth weight less than 2 500 grams, independent of gestational age and whatever the cause; It is the most important predictor of infant mortality rate especially neonatal. Objetive: to determine the prevalence of low birth weight and its associated factors in the Maternity Hospital German Urquidi of Cercado province of Cochabamba, Bolivia, during the administration I-2013. Methods: an observational study, quantitative, descriptive cross-sectional was conducted; with a sample of 926 boys and girls newborn; selected by random sampling, we consider a 95% confidence error where Alfa (α = 0,05) and Beta (Z 1- α = 0,76); accuracy d = 0,049%, calculated using the PASS Software 12.0. Results: of the newborns admitted in the study (926); the prevalence of low birth weight was 9,6%. It was determined that there gestational age with a shorter length at birth (r = 0,5373). Regarding the age of the mother with gestational age there was no statistically significant correlation (r = 0,005). Conclusions: The prevalence of low birth weight in our country was 9,6%, the main factors for low birth weight and gestational age were stunting the birth.

Medida de la mejora continua en la seguridad del paciente oncológico / Measurement of continuous improvement in the safety of oncologic patients

Objetivo: Analizar la mejora continua en la seguridad del paciente oncológico, a través de la evolución de los indicadores de calidad establecidos tras la implantación de un sistema de gestión de la calidad (SGC) según norma ISO 9001:2008, en una unidad de oncología farmacéutica (UOF). Método: Estudio observacional prospectivo realizado entre Enero 2008 y Diciembre de 2011. La certificación ISO 90012008 de la UOF incluyó los procesos de prescripción electrónica, validación, preparación, dispensación y administración del tratamiento antineoplásico. Se establecieron los indicadores de calidad: errores de medicación (EM) de preparación y dispensación que no alcanzan al paciente, y EM que alcanzan al paciente. Los indicadores se calcularon con una periodicidad trimestral a partir del aplicativo informático Farmis-Oncofarm®, se definió el estándar de cumplimiento en <1 EM por mil y el seguimiento se realizó mediante gráficos de control. Se definieron dos periodos "postimplantación" (2008-2011) y "preimplantación" (2007) y se aplicó la prueba estadística U de Mann Whitney para comparar la mediana del indicador en ambos periodos. Se consideraron diferencias estadísticamente significativas entre los periodos cuando p < 0,05. Resultados: Se realizaron 140.440 preparaciones en la UOF, para 4.770 pacientes, correspondientes a 52.906 pacientes-día. El cumplimiento del estándar durante la primera anualidad permitió su reducción a <0,5 EM por mil en los tres indicadores. En los EM de preparación se identificó un valor anómalo que implicó analizar sus causas y proponer propuestas de mejora. En el periodo postimplantación se redujeron los EM respecto al periodo preimplantación (p > 0,05). Conclusiones: El seguimiento de los indicadores de calidad permite medir y evaluar la seguridad farmacoterapéutica en el paciente oncológico. Tras la implantación del SGC en la UOF se han reducido los EM generados (AU)

Objective: To analyze continuous improvement in the safety of oncologic patients through the change of quality indicators established with the implementation of a quality management system (QMS) according to the ISO 9001-2008 regulation at a oncologic pharmacy unit (OPU). Method: Prospective and observational study carried out between January of 2008 and December of 2011. The ISO 9001-2008 certification of the OPU included the proceedings of electronic prescription, validation, preparation, delivery, and administration of the antineoplastic therapy. The following quality indicators were established: medication errors (ME), preparation and delivery errors not reaching the patient, and ME reaching the patient. The indicators were calculated quarterly through the Farmis-Oncofarm® software; the adherence standard was defined at < 1 ME per one thousand and the follow-up was done through control graphs. One "postimplementation" period (2008-2011) and one "pre-implementation" period (2007) were established and the U Mann Whitney test was used to compare the median of the indicator for both periods. The differences between the two periods were considered to be statistically significant when the p value was p < 0.05. Results: 140,440 preparations were made at the OPU, for 4,770 patients, corresponding to 52,906 patients-day. The adherence to the standard during the first one-year period allowed reducing the three indicators to < 0,5 ME per one thousand. For preparation ME an abnormal value was identified; the causes were analyzed and improvement measures were proposed. In the post-implementation period, ME were reduced during the post-implementation period as compared to the pre-implementation period (p<0.05). Conclusions: The follow-up of the quality indicators allows measuring and assessing the pharmacotherapy safety in the oncologic patient. After the implementation of the QMS at the OPU, the number of ME has been reduced (AU)

Exposición a fármacos citotóxicos en el personal sanitario / Exposure to cytotoxic drugs among health care professionals

Objetivo: Cuantificar los niveles de exposición del personal sanitario a fármacos citotóxicos con el fin de establecer el nivel umbral de exposición e implantar medidas para incrementar la protección y seguridad. Material y método La cuantificación de la contaminación de 5-fluorouracilo, gemcitabina y ciclofosfamida se llevó a cabo en las superficies de las siguientes áreas: cabina de seguridad biológica clase II tipo B3 (S1), mesa de preparación de tratamientos en antecámara (S2) y mesa de la sala de administración en hospital de día (S3). Se tomaron muestras de las superficies con un paño absorbente a tiempo t0, previo inicio de la sesión de trabajo, y t1, tras 3 h de trabajo mediante arrastre. En cada superficie se calculó el valor de la masa mediana respecto al valor basal y los percentiles 90, 75, 50 y 25 para cada citotóxico en μg/m2.Se comprobó la normalidad de la distribución con la prueba Shapiro-Wilk. El análisis estadístico incluyó las pruebas U de Mann-Whitney, Kruskal-Wallis y Wilcoxon. Se fijó el nivel de significación estadística para valores de p < 0,05.ResultadosSe recogieron un total de 90 muestras en total, 30 muestras por cada superficie de estudio. La masa media registrada de cualquier compuesto citotóxico fue superior en S1 y t1, con un valor de p = 0,017 y p = 0,004, respectivamente. Para cada fármaco citotóxico se fijó como valor objetivo el percentil 25 donde se obtuvieron valores de contaminación indetectables. Conclusiones La introducción de un programa de monitorización continua de superficies de diversos compuestos citotóxicos es esencial para fijar unos niveles aceptables de contaminación residual y reducir la exposición ocupacional (AU)

Objective: To quantify levels of exposure to cytotoxic drugs among health professionals in order to establish an exposure threshold and implement measures to increase protection and safety Material and method: Contamination with 5-fluorouracil, gemcitabine and cyclophosphamide was measured on work surfaces in the following areas: a class II type B3 biological safety cabinet(S1), a treatment prep table in an antechamber (S2) and a desk from the administrative room in the Outpatient Unit (S3). We took samples from the work surfaces by wiping them with an absorbent cloth at time t0, prior to the work session, and at t1 after three hours of work. For each surface, we calculated the median mass value with respect to the baseline value and the90th, 75th, 50th and 25th percentiles for each cytotoxin in g/m2.Distribution normality was assessed using the Shapiro-Wilk test. Statistical analysis included the Kruskal-Wallis and Mann-Whitney-Wilcoxon tests. Statistical significance was established for values of P<.05.Results: We gathered a total of 90 samples, 30 from each of the studied work surfaces. The mean recorded mass of any of the cytotoxic compounds was higher for S1 and t1, with values of P=.017 and P=.004 respectively. The target value for each cytotoxic drug was established at the 25th percentile, where undetectable contamination values were obtained. Conclusions: Introducing a continuous programme to monitor work surfaces for an array of cytotoxic compounds is fundamental in order to establish acceptable levels of residual contamination and reduce exposure in the workplace (AU)

Expresión diferencial durante la interacción Solanum tuberosum - Phytophthora infestans / Differential expression during Solanum tuberosum- Phytophthora infestans interaction

La papa (Solanum tuberosum L.) es el cuarto cultivo más importante a nivel mundial y es el producto agrícola con mayor demanda de fungicidas, insecticidas y fertilizantes quí­micos. Las pérdidas mundiales ocasionadas por Phytophthora infestans (Mont.) de Bary en este cultivo, ascienden a 6,7 billones de dólares al año y su control quí­mico genera un aumento en los costos, perjudica la salud humana y el ambiente. Todo esto justifica la búsqueda constante de mecanismos alternativos para el control de la enfermedad, entre ellos la obtención de variedades resistentes mediante cisgenesis usando genotipos silvestres. Como un aporte en este sentido, y dada la falta de conocimiento de lo que controla y constituye la diferencia entre una respuesta compatible e incompatible, en el presente estudio se compararon los perfiles de expresión génica obtenidos mediante Despliegue Diferencial de variedades resistentes y susceptibles durante su interacción con P. infestans. Los resultados evidenciaron diferencias en la expresión génica, tanto a distintos tiempos post-inoculación como en el tipo de cambio de expresión, incluyendo la presencia y ausencia de bandas diferenciales y el aumento o disminución en su intensidad. Al analizar las secuencias de fragmentos diferencialmente expresados, se encontró que algunos fragmentos sobre-expresados en las variedades susceptibles, tení­an homología con secuencias que codifican para una serina-acetiltranferasa y para la subunidad Β de la RNA polimerasa. Por su parte, fragmentos sobre-expresados en la variedad resistente, tení­an homología con una secuencia codificante para un dominio transmembranal.

Potato (Solanum tuberosum L.) is the fourth most important crop worldwide; also, is the agriculture product with most fungicides, insecticides and chemical fertilizers requirement. Worldwide losses caused by Phytophthora infestans (Mont.) de Bary in this crop, amount to 6,7 billion dollars per year and its chemical control increase production costs, harming human health and environment. For these reasons, is necessary constant research for alternative mechanisms to control disease, including development of resistant varieties using cis-genesis from wild genotypes. As a contribution in this way, and the lack of knowledge of what controls and is the difference between compatible and incompatible interaction, in this study we compared gene expression profiles obtained by Differential Display from resistant and susceptible varieties, during their interaction with P. infestans. The results showed differences in gene expression between resistant and susceptible varieties, at different times post-inoculation as well as exchange expression rate, including the presence and absence of differential bands and increase or decrease in their intensity. After analyzing the sequences of differential expressed fragments, we found that some overexpressed fragments from susceptible varieties had homology with an encoded sequence for a serine-acetyltransferase and for a RNA Polymerase Β subunit. On the other hand, overexpressed fragments from resistant variety, had homology with an encoded sequence for a transmembrane domain.

Estandarización de marcadores moleculares microsatélites para su uso en la industria forestal de Misiones, Argentina / Standarization of microsatellite molecular markers for Misiones (Argentina) forest industry

Provincia de Misiones posee actualmente una actividad forestal en pujante crecimiento ubicóndose entre las primeras del pais. Este marco de desarrollo productivo permite predecir un ámbito de crecimiento favorecido por las nuevas condiciones del mercado internacional. Por otro lado a pesar del avance de la tecnologi­a industrial, no se ha alcanzado el nivel de desarrollo biotecnológico óptimo que conjugue la calidad genética con caracterí­sticas fenotópicas de excelencia en las especies maderables de mayor demanda en la Provincia basó¡ndose la selección en criterios netamente fenotópicos y en la experiencia del productor, sin contarse con métodos moleculares desarrollados en la región. Este trabajo presenta los resultados del Proyecto Federal de Innovacíon Productiva (PFIP Mi09) cuyo objetivo principal fue estandarizar y transferir al sector productivo un conjunto de marcadores moleculares microsalites para ser aplicado al análisis de poblaciones y forestaciones de Araucaria angustifolia y Pinus taeda provenientes de la Provincia de Misiones (Argentina). Esto permitirá conocer el perfil genético de plantaciones y poblaciones de estas especies forestales, pudiendo aplicarse a la certificación de calidad en la producción forestal o a la selección de ejemplares de especies nativas.

Misiones Province currently has the first intensive forestry activity of Argentine. This framework of productive development allows predict an area of growth favored by the new conditions of the international market. On the other side despite the progress of industrial technology, has not been reached the optimal level of biotechnological development that combining quality with genomic and phenotypic characteristics of forest species. This work presents the results of Federal Project of Productive Innovation (PFIP Mi09) whose main objective was standardize and transfer to the productive sector a set of microsatellites molecular markers to be applied to the populations analysis of Araucaria angustifolia and Pinus taeda forestation from the Misiones (Argentine). This will reveal the plantations and forest genetic profile and may be applied to genetic certification of forest production quality.

Melatonina inhibe la respuesta de cortisol a ACTH: posible mediación a través del gen reloj Per1 / Melatonin inhibition of the cortisol response to ACTH may be exerted through period circadian protein homolog 1 (Per1)

Background: Circadian cortisol production results from the interaction of the circadian production of ACTH, the autonomic nervous system and intrinsic factors within the gland. An additional regulator is the neuro-hormone melatonin. In human adrenal gland cultures, melatonin inhibited ACTH stimulated cortisol production and Per1 mRNA expression. ACTH actions on the adrenal involve early and late responses. Aim: To investigate the effects of melatonin on the time course of ACTH stimulated cortisol production and of Per1 expression in the lamb adrenal gland. Material and Methods: Adrenal glands and plasma of five newborn lambs were obtained. Adrenal glands were cut in 15 mg explants. Three of these explants were stored for RNA extraction. The rest of explants were using in different culture protocols with ACTH and melatonin. Results: Lambs had an in vivo a circadian variation in plasma cortisol and in adrenal Per1 expression. In vitro, ACTH stimulated an early and late increase in cortisol production and an early increase in Per1 expression reaching a maximum at 3 hours of treatment. Melatonin inhibited the early Per1 response to ACTH without affecting the early ACTH stimulated cortisol production. However, melatonin inhibited the late response of cortisol production to ACTH. Conclusions: The inhibitory actions of melatonin on Per1 response to ACTH may contribute to the inhibitory effects of melatonin on adrenal steroidogenic response to ACTH.

Caso clí­nico: reactivación de psoriasis posterior a adrenalectomía por sí­ndrome de Cushing / Case report: psoriasis relapse following adrenalectomy for cushing syndrome

The relapse of autoimmune diseases following resolution of Cushing syndrome (CS) has been established with frequency, especially for thyroid disease. We present the case of a 39-year-old woman with a history of psoriasis vulgaris, with no other comorbidities. She presented a one-year of weight gain, high blood pressure, hypermenorrhea, pre-diabetes and dyslipidemia. During this period of time, the complete remission of psoriatic lesions was confirmed. The laboratory analysis demonstrated elevated free urinary cortisol in two opportunities, and a confirmatory low-dose dexamethasone test. Low ACTH levels were established (12,3pg/ml), and the abdominal images where compatible with a right adrenal adenoma of 3,0 x 2,3 cm, sothe patient underwent a laparoscopic right adrenalectomy with no complications. Her blood pressure, glucose and cholesterol levels improved following surgery. One month after surgery the patient developed new, generalized psoriatic plaques. The excess of glucocorticoids produced by the adrenal tumor could have controlled the immunopathogeny of psoriasis. By removing the tumor, with the consequent reduction of cortisol levels, a more severe relapse of her cutaneous disease occurred.